CHAPTER  9 INFECTION CONTROL Infection control involves taking steps to prevent the spread of infectious agents. Your command will develop standard infection control policies and written protocols  following  BUMEDINST  6600.10.  COs  and OICs must appoint in writing an infection control officer (ICO) to assist in implementing the infection control  program.  Material  in  this  chapter  and  in chapter 10 are taken from BUMEDINST 6600.10, Dental  Infection  Control  Program.  Some  of  the information  may  be  different  from  what  your command policies and procedures are for infection control. COs and OICs may adapt the policies and procedures from BUMEDINST 6600.10 to meet their local  conditions  and  criteria.  Compliance  with BUMEDINST   6600.10   is   mandatory.   If   your command  has  significant  variations  from BUMEDINST 6600.10, the ICO must document in the infection  control  manual  the  reasons  for  those  changes. All dental personnel must be aware of sources and methods  of  transmission  of  pathogenic  micro-organisms and infectious diseases. The emergence of the human immunodeficiency virus (HIV) epidemic, along with recent reports about health care workers who have acquired  an  HIV  infection  through  occupational exposure, has generated much fear and worry within all the health professions, including dentistry. Healthcare personnel are caught in a conflict between concern for their patient’s needs on the one hand and fear of acquiring HIV infection on the other. Adding to this dilemma is the problem of the hepatitis virus (HBV) infection, a major infectious occupational  health  hazard  in  all  the  healthcare professions. Each year, several thousand healthcare workers become infected with the HBV. The Center for Disease  Control  (CDC)  estimates  that  HBV  infection  in healthcare personnel actually results in some 600 hospitalizations and 200 deaths annually. These concerns have led to a renewed interest in the problem of infection control in the dental health care environment. CLASSIFICATIONS OF MICRO-ORGANISMS Microbiology is the study of microscopic life forms referred to as micro-organisms. They are so small that they can only be seen with the aid of a microscope.  Micro-organisms  are  always  present in  our  environment;  most  live  in  warm,  dark surroundings where adequate food supply exists. The oral cavity is one such area where enormous numbers of micro-organisms commonly exist and multiply. A pathogen is an organism capable of causing disease. Disease producing organisms are said to be pathogenic. Other   micro-organisms   that   are   not   considered pathogenic  can  produce  infections  under  favorable conditions. Micro-organisms are classified as bacteria, bacterial spores, viruses, protozoa, and fungi. BACTERIA Bacteria   are   one-celled   plants   that   lack chlorophyll (the chemical that provides the green coloring to plants). A single drop of water may contain as many as two billion medium-sized bacteria. Some diseases   caused   by   bacteria   are   dental   decay, periodontal disease, and tuberculosis. The three main types and shapes of bacteria are as follows: 1. Cocci—spherical and shaped like small beads 2. Bacilli—rod-shaped 3.  Spirochetes—spiral-shaped Gram Positive and Gram Negative Bacteria Certain antibiotics treat different types of bacterial infections. A liquid dye called gram stain is used on the bacteria to determine if they are gram negative or gram positive. Bacteria that are stained by the dye and turn a dark purple  color  under  microscopic  study  are  called gram-positive bacteria. If no color exists after staining and viewing, the bacteria is called gram negative. A dental officer may submit a bacterial culture to the medical laboratory to determine if it is gram positive or negative  before  prescribing  an  antibiotic  to  treat  an infection. 9-l